Public Health Emergency Preparedness

Anthrax

Anthrax Fact Sheet

• • What is anthrax?
• • What are the different types of diseases of anthrax?
• • What are the symptoms of anthrax?
• • Who gets anthrax?
• • How is anthrax spread?
• • How soon after anthrax infection do symptoms appear?
• • Is anthrax contagious?
• • How is anthrax diagnosed?
• • What is the treatment for anthrax?
• • Is there an anthrax vaccine, and how can I get it?
• • What has New York City done to address the threat of anthrax?

What is anthrax?

Anthrax is an acute infectious disease caused by the spore-forming bacterium Bacillus anthracis. Anthrax most commonly occurs in wild and domestic livestock (such as cattle, sheep, and goats), but infections can occur in humans as well. In the fall of 2001, an outbreak of cutaneous and inhalation anthrax in New York City, New Jersey, the Washington, D.C. area, and Florida resulted from a still unsolved act of bioterrorism involving letters intentionally contaminated with anthrax spores.

What are the different types of diseases of anthrax?

Cutaneous (skin): Cutaneous anthrax is marked by a boil-like lesion that typically forms an ulcer with a black center. While cutaneous anthrax infections account for about 95% of all human anthrax cases, there are two other rare forms of anthrax.

Inhalation (lung): Initial symptoms of inhalation anthrax may resemble the common "flu" and include fever, muscle ache, mild cough, and chest pain. After several days, the symptoms may progress to severe breathing problems and shock. Without immediate treatment, inhalation anthrax is usually fatal.

Intestinal: This is the rarest form of anthrax disease and can occur in the upper (throat) or lower (abdomen) intestinal tracts. There has never been a documented case of intestinal anthrax in the United States.

The intestinal form of anthrax may occur after a person eats uncooked or undercooked food that is contaminated with anthrax. It causes acute inflammation of the intestinal tract. The first symptoms of intestinal anthrax include nausea, loss of appetite, vomiting, and fever. These symptoms are followed by severe throat or abdominal pain, vomiting of blood, diarrhea, which can be bloody, or abdominal bloating. Unless antibiotic treatment is started shortly after symptoms begin, intestinal anthrax is usually a fatal disease.

Meningeal (brain): This can occur if anthrax bacteria enter the bloodstream following cutaneous, inhalation or intestinal anthrax infection, and from there spread to the brain. Symptoms include sudden headache, nausea, vomiting, muscle aches, chills and dizziness. This usually cannot be treated successfully.

What are the symptoms of anthrax?

Symptoms usually occur within seven seven days, and they differ depending on the type of anthrax disease. If anthrax spores entered through a break in the skin, an itchy pimple (it often has been compared with an insect bite) appears, grows in size and then turns into a painless ulcer, followed usually by a black scab. Sometimes, fever, muscle aches and swollen lymph glands can occur. Other types of anthrax usually begin with “flu-like” symptoms – fever, muscle aches, chills, and general weakness. This is followed within a couple of days by other symptoms that depend on the type of anthrax disease that a person has. Inhalation (lung) anthrax causes cough, chest pain and breathing difficulty. A person with intestinal anthrax will get throat or abdominal pain, vomiting, diarrhea or abdominal bloating. Meningeal (brain) anthrax causes severe headache, vomiting, nausea and dizziness. Persons with these last three types of anthrax disease become extremely ill very soon after these. Initial symptoms of cutaneous anthrax may include "flu-like" symptoms, such as a low-grade fever and general fatigue. Lymph glands may swell. A boil-like lesion that eventually develops an ulcer with a black center will form on the skin. If symptoms do not develop within two weeks of exposure, there is only a remote chance of developing cutaneous anthrax disease.

Who gets anthrax?

Anthrax is most common in agricultural regions of the world where anthrax in animals occurs, including: South and Central America, Southern and Eastern Europe, Asia, and Africa. Anthrax occasionally occurs in animal herds in the United States as well, but until 2001, cases in humans were rare. Typically, when anthrax affects humans, it usually is from an occupational exposure to infected animals or animal products, such as wool, hides and/or hair. However, those at-risk during the 2001 outbreak included persons who had come into contact with contaminated mail, such as postal, news media, and government employees.

Contaminated African animal hides have been involved in a number of recent anthrax infections. A NYC resident was diagnosed with inhalation (lungs) anthrax in February 2006. He was infected after using a contaminated African animal skin to make an African drum. In summer 2006, a Scottish citizen died from inhalation anthrax after taking part in a drumming class where contaminated African drums were used. Two Connecticut residents also were diagnosed with cutaneous anthrax in fall 2007 after at least one contaminated African animal hide was used to make a traditional African drum. To reduce the potential risk from contaminated animal hides, it is recommended that drum makers purchase domestic hides that have been treated by a professional to reduce the number of spores.

How is anthrax spread?

Anthrax can be spread three ways: (1) through cutaneous (skin) contact with anthrax spores, such as from infected animals or animal products including hair, wool, or hides (or from intentionally contaminated letters, as occurred in fall 2001); (2) through inhaling (breathing in) anthrax spores, especially in industrial processes like tanning hides and processing wool where aerosols of anthrax spores may be produced; and through (3) ingesting (eating) contaminated, undercooked meat. Anthrax is not spread through animal milk. Anthrax is almost never , and cannot be spread from one person to another person.

How soon after anthrax infection do symptoms appear?

Generally, the incubation period is seven days or less. Most cases of anthrax occur within 48 hours of exposure. However, although less common, inhalation anthrax can develop more than six weeks after exposure to inhaled anthrax spores.

Is anthrax contagious?

Inhalation (lung), intestinal and meningeal (brain) anthrax cannot be spread from person to person. Even after the development of symptoms of inhalation anthrax, persons are not contagious to others. With cutaneous (skin) anthrax, the drainage from an open sore presents an extremely low risk of infection. The only way cutaneous (skin) anthrax can be transmitted is by direct contact with the drainage from an open sore. Anthrax is not spread from person to person by casual contact, sharing office space, or by coughing or sneezing.

How is anthrax diagnosed?

Anthrax is diagnosed by culturing the bacteria from blood, skin lesions, or respiratory secretions. Special confirmatory testing of suspicious bacteria is then done at governmental public health reference laboratories. Other available tests include antibody assays and detection of the anthrax DNA in a tissue or blood specimen.

What is the treatment for anthrax?

Doctors can prescribe antibiotics to treat anthrax. To be effective, treatment should be started as soon as possible after anthrax infection is suspected. While anthrax – especially cutaneous anthrax can be treated – is easily treated with antibiotics, it may be fatal if not treated at all or if treatment is delayed. Inhalation (lung), intestinal and meningeal (brain) anthrax are much more severe infections. Successful treatment would require antibiotics, medical procedures and long stays in hospital intensive care units.

Is there an anthrax vaccine, and how can I get it?

The anthrax vaccine requires 6 shots over an 18-month period with periodic boosters. It is not available commercially and currently is available only for military personnel thought to be at higher risk for potential exposure to anthrax in combat settings. The U.S. Centers for Disease Control and Prevention (CDC) maintains a supply of anthrax vaccine that would be available to state governments for emergency use.

In December 2001, the U.S. Centers for Disease Control and Prevention (CDC) made the anthrax vaccine available to people who may have been exposed to anthrax spores and who were advised by their local, state, or federal health authority to complete a 60-day course of antibiotics. Only a small number of New Yorkers who were directly exposed to the anthrax-contaminated letters at the media worksites or the main Manhattan postal facility were offered vaccine.

What has New York City done to address the threat of anthrax?

Many federal, State, and City agencies-including the New York City Department of Health and Mental Hygiene (DOHMH)-have been working together for several years to prepare for the detection and response to a bioterrorist event in New York City. In cooperation with other emergency response agencies, DOHMH has established a comprehensive surveillance system to improve our ability to detect and respond to the release of a biological agent.

As part of this plan, the DOHMH continuously looks for any indication of bioterrorism in the City. DOHMH regularly asks all health-care providers in New York City to be alert for any unusual disease clusters, and to immediately report such occurrences to us. Additionally, several surveillance systems are in place to quickly detect an increase in unusual illnesses, including monitoring of 911-ambulance calls and emergency department visits. The response plan includes coordinating with OEM and other City, State, and federal agencies; alerting hospitals and the medical care community; communicating with the public; and ensuring that appropriate medical care and prevention services are provided.

For more information on this program, visit the CDC Web site at www.bt.cdc.gov.

Last Updated January 2008